Provider Demographics
NPI:1447517974
Name:MOSSALLATI, ADAM SAAD (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:SAAD
Last Name:MOSSALLATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1684
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71165-1684
Mailing Address - Country:US
Mailing Address - Phone:318-424-6004
Mailing Address - Fax:858-230-1466
Practice Address - Street 1:1111 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-3841
Practice Address - Country:US
Practice Address - Phone:318-716-4770
Practice Address - Fax:318-716-4791
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA301711208100000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist